HomeMy WebLinkAboutFilled Land Affidavit PLANNING& DEVELOPMENT SERVICES DEPARTMENT
Rs-7TZ_- 41,1
COUNTY Building&Code Regulations Division
F O_L_I_D 11 2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
1,the undersigned, am the owner of the following described property,
gle 6 1!4 lew
(Parcel ld#/Legal descripfion/Address)
for which I have applied to St. Lucie County for a Final Development Permit.. In
accepting this Final Development Permit, BP Number I acknowledge
that as owner of the above described property,- and in accordance with Section
7.04.01(D), St.Lucie County Land Development Code,I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit .for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
//A/
Property Owner Name(Please Print)
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Property Owner Signature Dke
STATE OF FLORIDA,COUNTY O�A.
ACKNOWLEDGED BEFORE ME THIS DAY:OF ec —20-
BY�RM,l 4kh n q'r - WHO IS PERSONALLY KNOWN TOME ZbOR WHO HAS
PRODUCED -AS IDENTIFICATION.
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ATURE OtAO' Y LIC TYPE OR PRINT NOTARY/ V
COMMISSION NUMBER
(SEAL)
SLCPDSD Revised 04/11/2011
A 'REY B.
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PH
N#FF 4772
kv 60%,iNIISSIC
019
EXPIRES:,Aarch 6,2019
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